First come the A-list: the people who have been good, at least to him.

The pharmaceutical companies already got their gift that will keep on giving for many holidays: Medicare D, the drug benefit. Under the rules, the government will not negotiate for lower prices, guaranteeing Big Pharm a sellers market. What a generous Santa!

Next are the private health insurers, and their stockholders. Santa Bush has shown throughout the past eight years how much he loves these people who have loved him back. He has held firm: the government will not encroach on the turf of the private insurers. So even though 47 million Americans have no insurance, and many of those with insurance have small-print exclusions and caps that render those enrollees under-insured, Santa Bush has pledged his support. The private sector insurers must have been very good this past year.

Further down are the cell-saviors. They love life as much as Santa Bush loves them. They hold embryonic stem cells sacred. Even though most of these cells, the leftovers (a harsh word, admittedly, but an apt one) from in-vitro fertilization are destined to deteriorate, or be discarded, the self-appointed saviors dont want the cells used for research. Even if parents want researchers to use the cells, the cell-saviors say no. Santa Bush has echoed that no.

The X-list comes next: the people who dont rate holiday beneficence. Santa Bush, though, wont be giving out coal. That reeks of 19th century Scroogian meanness. How much cleaner, and easier, to give  nothing!

Here are the people destined for empty health-care stockings:

First come those children sucking up state and national treasuries. Medicaid and the States Childrens Health Insurance Program cover a major swathe of the nations children  an expensive budgetary drag, and an unfair one. Their profligate parents should be digging deeper into their own pockets to insure their children. Santa Bush has other responsibilities. So this holiday Santa Bush has decided that children whose parents earn above a certain limit will not get state-subsidized health insurance. When Congress tried to extend SCHIP, Santa Bush gave the expectant children a veto.

Veterans havent been especially nice either. The ones injured in service will get government-sponsored care, though congressional committees and muckraking journalists are questioning the quality of that care. But up to 1.8 million veterans (12.7% of non-elderly veterans) will get nothing in their stockings. They dont merit post-service health insurance. (Himmelstein, Woolhandler et al. Lack of Health Insurance Coverage Among US Veterans from 1987 to 2004, American Journal of Public Health, December 2007). Uncle Sam insured them during their service. Thats enough.

Last are the people with chronic illnesses: Alzheimers, Parkinsons, diabetes, multiple sclerosis, muscular dystrophy. These people are good for campaign photo-ops, but not good enough to get on Santas A-list. These people want better treatments  ideally, a cure  if not for them, for future generations. They want the government to open its coffers for research. They want the government to fund stem cell research. Santa Bush has given them platitudes.

Maybe next year the X-listed should pray for a Miracle on Pennsylvania Avenue.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.